Parliamentary Committees

Social Development Committee: Inquiry Into Regional Health Services

Ms WORTLEY (Torrens) (11:03): I move:

That the 40^th report of the committee, entitled Inquiry into Regional Health Services, be noted.

On behalf of the committee, I thank the member for Taylor for moving that the inquiry, referred by the member for Stuart, be undertaken by the Social Development Committee. I acknowledge and thank the many individuals and organisations who provided written submissions and those who also appeared before the committee. The evidence provided on matters concerning country communities has assisted the committee in its inquiry and in reaching the recommendations toward improving the country health system.

I thank, in the other place, the Presiding Member, the Hon. Gail Gago, and members, the Hon. Kelly Vincent and the Hon. Jing Lee. In this place, I thank the member for Hammond and the member for Fisher. My thanks also to the parliamentary staff for assisting the committee.

The inquiry has been a long and complex one with the committee hearing evidence from many stakeholders who live and work in regional and rural areas of our state and who have direct experience with the country health system and the changes brought about by the Health Care Act 2008. In addition to the 71 written submissions received, the committee held a number of hearings in Adelaide, as well as in the South-East, Riverland, Flinders and Upper North regions.

It should be acknowledged that each of the terms of reference could potentially have been a single inquiry. Certainly, the evidence received indicated that there was concern in many country communities over the depth of some of the issues. These have taken time to draw out and to understand the impacts for each of the stakeholder groups in those communities. The committee considers that the length of time it has taken to conduct the inquiry and finalise the report before you today has been warranted.

In general, the inquiry was to review the delivery of country health services, predominantly in relation to the functioning of health advisory councils. However, there are also those terms of reference that required examination of other aspects of the country health system: those which went beyond the role and responsibility of the health advisory councils. The Health Performance Council's 2011 review found that health advisory councils were generally ineffective in their roles and that the health system was not supportive enough in administering the 2008 legislation when it commenced. As a result, Country Health SA undertook to raise the profile of health advisory councils and engage local communities in communication and collaboration with the local health networks.

This inquiry has seen some of these goals met, including the Country Health strategic plan and consumer engagement strategies. Country Health was very positive about the gains made with these key policy frameworks. The health advisory councils, however, feel that they need to be further supported to allow greater headway to be made from the Health Performance Council's 2011 review.

The second part of the reference refers to the delivery of health services in regional South Australia and the role and responsibilities of the health advisory councils. Twenty-two of the 39 health advisory councils responded to this inquiry. There are examples of health advisory councils that are coping well with their responsibilities and the role they have in their communities. Others appear to either not know of the full scope of functions provided to them under the act or are unable to utilise them. Issues raised include difficulty in establishing a cohesive identity, confusion about their role and what their purpose is, problems engaging with the community, loss of influence and power and feeling disempowered in decision-making processes.

The committee notes that some health advisory councils are functioning very well as healthcare advocates and fundraisers and have excellent relationships with their individual regional directors. Others told the committee that they did not feel there were clear lines of access to Country Health executive staff. These problems appear to have developed out of deficiencies in communication and a lack of collaborative approaches between Country Health SA and health advisory councils over a long period of time. In relation to terms of reference 2(b) through to 2(m), the committee found that there were a range of issues that ran contrary to the intentions of the Health Care Act. These include:

Hospital budget decision-making: the committee received evidence that while most health advisory councils do not want to manage annual hospital budgets, they do want to have an input into them. The committee recommends Country Health SA develop guidelines to support this to occur.

Consultation with health advisory councils in the hiring of senior hospital staff: some health advisory councils advised that they were not consulted in the process of hiring senior hospital staff and expressed their desire to be involved. The committee has recommended that Country Health SA develop clear guidelines for this consultation to occur.

Service planning: while health advisory councils are mentioned in the Country Health strategic plan for 2015-2020, there is a need to acknowledge their capacity for input into the healthcare service planning. The committee recommends that Country Health SA recognise health advisory councils in core policy documents and continue to collaborate with them on the local 10-year health plans.

Expenditure of donated money, procurement practices and building maintenance: the committee has made recommendations to increase transparency and accountability and give some control back to the community over how these funds are allocated. Measures should include an increase in the maximum threshold amount health advisory councils can spend before approval by the Minister for Health is required.

In relation to the dedicated work of the South Australian Ambulance Service, the committee received evidence regarding inefficiencies and pressures brought about from increases in low acuity patient transfers, the length of time to train volunteers and the need to increase volunteer recognition. The committee has made a number of recommendations that address these and other points of issue discussed in the report. For example, it is recommended Country Health SA continue working with SAAS in developing a memorandum of understanding for the low acuity patient transfers and other processes to assist volunteers.

In relation to SA Health procurement practices, evidence suggests that a review be made of the one-size-fits-all approach for country hospitals, particularly for those that are very small or a great distance from a regional centre. Evidence also suggests the procurement processes, whilst they aim to improve practices, can be restrictive to the health advisory councils and health services to which they are attached.

The committee heard the mandated use of DPTI as the across-government building management service provider can be a problem for some of the health advisory councils. For some types of building work it is expedient, practical and financially beneficial for DPTI services to be engaged. For others it has had a detrimental effect on local economies. The committee has recommended that the across-government facilities management arrangements be reviewed and health advisory councils given greater discretion to use a service provider of their choice.

The issue of medical workforce planning affects the whole of Australia's regional areas. While South Australia has higher than average number of GPs, they are not distributed evenly across the metropolitan and regional areas. The committee recommends Country Health SA revisit the 2010 report of the Rural Doctors Workforce Agency, 'Road to rural general practice', and consider implementing the suggested model pathway to increase rural GP numbers.

The committee also recommends that Country Health SA undertake to do further work with the Australian Nursing and Midwifery Federation (SA Branch) in furthering the development and implementation of the Country Health SA nursing and midwifery workforce attraction, recruitment and retention policy for the whole of South Australia. The committee has made a number of other recommendations aimed at achieving equitable distribution of medical staff in country areas.

In relation to the Enterprise Patient Administration System (EPAS), the committee received evidence of problems, challenges and technical concerns when it was first introduced, many of which have now been resolved. It is worth noting that the majority of concerns raised in relation to EPAS came from less experienced users such as GPs who consulted at the hospital on an irregular or infrequent basis. However, further improvements can still be made in areas such as data capture, and the committee has made a number of recommendations towards addressing this.

One of the highlights of this inquiry has been seeing how the integrated mental health inpatient units have benefited regional communities. There are now integrated mental health inpatient units in Berri, Whyalla and Mount Gambier, with occupancy levels at approximately 85 per cent. The committee travelled to Whyalla and received a tour of that unit. The committee commenced the implementation of the integrated mental health inpatient units and the work of the dedicated staff.

For a patient suffering from an episode of mental illness, the journey to recovery can be long and requires a multipronged approach for mental health professionals. The integrated mental health inpatient units form part of the circle of care in a patient's journey. The committee has made a recommendation for the Minister for Health to review the need to implement additional units in country areas.

The committee considered a number of other matters during the inquiry such as the efficacy of the Patient Assistance Transport Scheme, the administration of aged-care services and the linkages between primary, acute and tertiary care services. The report contains several recommendations for Country Health SA to review and continue to make improvements to these services.

In conclusion, I want to highlight again the immense contribution regional and rural communities make to our state's country healthcare system and the importance for these communities to be included in discussions about how the healthcare system is planned and governed. The report provides recommendations to garner potential for more extensive collaboration between Country Health SA, the health advisory councils and their local communities. It recommends a partnering approach and provides suggestions for health advisory councils to continue expanding the functions and capabilities of their role in accordance with the act. I commend the committee's report and the recommendations.